Psychological Aspects of Chronic Pain
By Peter Mosbach, PhD

Chronic pain can be a significant source of emotional distress for people, placing them at risk for developing symptoms of depression and anxiety. There are a number of factors that can contribute to the presence of these psychological symptoms.

One major source of anxiety is the financial stress associated with being disabled. Many people with chronic pain are unable to work and have a significant lose of income. Income loss frequently produces strain in marital and familial relationships.

Worker's compensation and private disability programs typically pay 60 to 66 percent of a worker's prior wage, producing a significant loss of income. Individuals who do not qualify for worker's compensation or private disability insurance can apply for social security disability (SSDI), but this typically takes 12 to 18 months to be approved. Individuals with chronic pain also have higher expenses due to their increased need for medical care. Dealing with the worker's compensation system, private disability insurers, and Social Security (SSDI) can also produce anxiety, as interactions with these agencies are often adversarial in nature.

Losing the ability to work can decrease self-confidence and self-esteem, which can cause or exacerbate depression. This can also lead to social isolation and loss of social support, since many people receive a significant proportion of their daily social interactions in the work environment.

Another factor that can contribute to emotional distress is the loss of sexual functioning experienced by many people with chronic pain. This can also lead to a reduced level of self-esteem and cause stress in relationships.

Chronic pain can exacerbate previously existing psychiatric symptoms. Individuals who have had psychiatric symptoms, including depression and anxiety, prior to their chronic pain problems are likely to experience a worsening of their pre-morbid condition. Thus, it can be useful to assess for the presence of pre-existing psychiatric disorders, because they are a risk factor for significant psychological symptoms in response to chronic pain.

What can be done about the increased risk of depression, anxiety and other psychiatric disorders among individuals with chronic pain? The first goal is to conduct an assessment by directly asking patients if they are experiencing any psychiatric symptoms in response to coping with their pain. The use of cognitive behavioral pain management techniques has been shown to be helpful. In addition, relaxation training, using methods such as biofeedback, has also been shown to be helpful. Increasing social activities can also be useful. Medications including antidepressants and anxiolytics also can be of use.

Peter Mosbach, PhD, is a psychologist and assistant clinical professor in the Department of Neurology at Boston University School of Medicine.